Provider Demographics
NPI:1598939407
Name:LIGHTHOUSE PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PROFESSIONAL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:563-382-1900
Mailing Address - Street 1:1111 PAINE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2411
Mailing Address - Country:US
Mailing Address - Phone:563-382-1900
Mailing Address - Fax:563-382-1777
Practice Address - Street 1:1111 PAINE ST
Practice Address - Street 2:SUITE D
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2411
Practice Address - Country:US
Practice Address - Phone:563-382-1900
Practice Address - Fax:563-382-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty